Refills For Current REV Clients

If you need a refill of your medication or supplies, please complete the form below.

-We will reply with an online Invoice (for your security, we no longer save credit card info)

-Delivery is typically 2-3 business days. Same day processing and next day (Overnight) delivery is available for a $50 service charge - restrictions apply.

-Most medications arrive ‘on ice’ and need to be refrigerated upon receipt - let us know if a certain delivery date isn’t good for you in the Additional Info section below. “Powdered” Trimix products can take up to two weeks for delivery.

-We are required to keep a Photo of our clients to provide Refills - we may ask you to send us a face picture, if we don’t have one on file for you - This is for our internal record keeping only and will never be shared.

If you have questions please email us at, call us (917) 397-4738

Name *
Date of Birth *
Date of Birth
Delivery Address *
Delivery Address
EP - Trimix/Bimix/Quadmix Refills